肾小球疾病间质泡沫细胞的分布及其与临床指标的关系

Significance of renal interstitial foam cells in patients with giomerular disease

目的观测各种病理类型肾小球疾病间质泡沫细胞的分布特点及其与临床参数间的关系。方法选取2862名肾活检患者为研究对象，观察间质泡沫细胞浸润常见的病理类型及泡沫细胞的分布特点。对诊断明确的Aploa综合征（AS）5例，膜增生性肾小球肾炎（MPGN）28例，局灶节段硬化性肾小球肾炎（FSGS）144例，特发性膜性肾病（IMN）132例，IgA肾病（IgAN）893例按间质是否存在泡沫细胞进行临床参数的比较。结果（1）非继发性肾小球疾病泡沫细胞浸润高发的病理类型依次为AS（100％）、MPGN（46．43％）、FSGS（21．32％）、IMN（13．64％）、IgAN（6．69％）；（2）泡沫细胞浸润组24小时尿蛋白定量、血胆固醇水平以及反映肾小管功能损伤的指标均高于无泡沫细胞组（P〈0．05）。结论肾间质泡沫细胞浸润常见于AS，但在MPGN、FSGS、IMN和IgAN患者中均可出现，大量蛋白尿与高脂血症是导致泡沫细胞浸润的两大因素。间质泡沫细胞的浸润与间质损害有一定的关联。

Objective To observe the distribution of renal interstitial foam cells in the different pathologic types of glomerular diseases. To evaluate the relationship between infiltration of foam cells in renal interstitial and clinical parameters. Methods 2862 patients who had received renal biopsy were en- rolled in our study. The patients with Alport syndrome （ AS, n = 5 ）, membranous proliferative glomerular nephritis （ MPGN, n = 28 ）, focal segmental glomeruloselerosis （ FSGS, n = 144 ）, idiopathic membranous nephropathy （ IMN, n = 132 ）, IgA nephropathy （ IgAN, n = 893 ） were divided into two groups as FC ＋ group with foam cells infiltration and FC- group without foam cells infiltration. Results （ 1 ） The percent- age of interstitial foam cells was 100% in AS ,46.43% in MPGN,21.32% in FSGS, 13.64% in IMN and 6.69% in IgAN. （2）The level of proteinuria, serum cholesterol and indexes of tubulointerstitial injury were significantly higher in FC ＋ group than FC _ group. Conclusions The renal interstitial foam cells arc most common in patients with AS, but also can be seen in patients with MPGN, FSGS, IMN and IgAN. Mas- sive proteinuria and hyperlipidemia are the major factors for the formation of foam cells in the renal inter- stitium in patients with glomerular disease. The present of foam cells in the renal interstitium may contribute to the injury of renal interstitial.